Provider Demographics
NPI:1548473960
Name:KHOSROWABADI, REZA (MASTERS)
Entity type:Individual
Prefix:
First Name:REZA
Middle Name:
Last Name:KHOSROWABADI
Suffix:
Gender:M
Credentials:MASTERS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4806 HOLLOW CORNER RD UNIT 234
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-8581
Mailing Address - Country:US
Mailing Address - Phone:310-204-5205
Mailing Address - Fax:818-755-8789
Practice Address - Street 1:6736 LAUREL CANYON BL.
Practice Address - Street 2:200
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606
Practice Address - Country:US
Practice Address - Phone:818-755-8786
Practice Address - Fax:818-755-8789
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator